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26 Jan 2022

Category: identityCategory Archives:

The Prosumer

We, the undersigned, are declaring our unique identity among ‘mental patients’, psychiatric survivors, and the many plurals(s) (yet singular), and very heterogenous, dynamic shades of people with lived experience with mental health diagnosis. 

It may help to think of the document as a flag. Within the margins is our essay signaling our protected status. We are far too vulnerable given the current status of Mental Health Affairs in the US, and Western Europe. Ultimately, consider this as a call to arms for all people marginalized, ‘othered’ and existing without the privilege of the norm. 

The irony is that the ‘mental patient’ is the farthest thing from the norm. And yet, within the history of emerging identities in the mental health movement, are more dominant, accepted, and known subsets and subgroups of the greater population of people with lived experience. 

We live in two worlds, to start. Of you are going to count and get very specific about things (this essay is going to become far too abstract to do so so don’t even try) we live in many more worlds than two, and even occupy some shooting stars and meteors in the vast constellation of disordered, sick, and needing mental health treatment.

Parts of these worlds are bound up in persistent illusions, intrigue, paranoia, and certainly the seductive pull of every symptom suggesting our health has been compromised at some point in our lives. Our worlds were eclipsed at one time. The changes were unwelcome. The challenges we faced were partly meaningful and party disturbing. This may depend on which, when, and how you ask about each change, as we transformed into our prosumer identity.

For us, the undersigned, we experienced what some term as first-episode psychosis. We have the right to use, speak, and think in clinical terms, because on the other side, in that other world we share, we are professional and very savvy with our knowledge of mental health as professionals in the land of social work, psychology, and all the intersections of health and health from a scientific lens. The spiritual awakening we passed through is not one insight, or two, into any disorder, but into ‘being’ as it pertains to the transformation of life.

This is a declaration of independence from our peers and conversely, an olive branch of goodwill and promise of support, even if the feelings to date have not been mutual. Historically, we have been caught in flux, and this is a space as toxic and hazardous as the inside of a locked asylum. Even worse, it is a space of betrayal, disillusionment, and chronic rejection. 

Ya Basta! Enough is enough!’

We need and demand independent and protected status among peers. After all, psychotherapy and medication aren’t enough for the common, ‘mental patient’ so why should we go without peer support? Something has been missing for many of us prosumers. Between understanding our diagnosis, accepting it radically, and beginning to separate our personality from illness, reconceptualizing and actualizing the self.  Most of our waking hours continue to be consumed by persecution, hatred, and jealously. 

At that very moment, I realized healing wasn’t just a matter of doing. That being proactive is not the only catalyst to create a space for healing was the first step in our path to providence, independence, and debunking the greatest myth of all in recovery. Healing comes from a shift, over time, narrating and re-building our personal future through invention and imagination. The myth is so hard to unearth because it sits right next to the truth. Yes, that (re) part is the myth. For there is no ‘re’ anything in recovery. 

‘Re’ suggests a reversal or looking back. Recovery is only forward, and always further along in our history from the moment when illness overtook us and wreaked the havoc that made us who we are today. 

This document is just that, ‘us’, or we prosumers maintaining our right to a  future. After all, we too, have a lifetime of healing ahead. 

If taken seriously, we social workers are appealing to the language. Our core beliefs are undefined and require mutual partnership. We are doing more than appealing here. Nay, we are demanding that our integrity and the merits of our research, practice, and experience be heard and accepted among the already defined and written mental health patients and professionals out there in the system. 

Social work in the strengths-based perspective is a language of healing. Lived experience is a language of imagination and the capacity to see our healed selves during the process and the charting of our recoveries. 

All people deserve a future. The right to build, plan and make visible a personal road map through recovery at the intersection colliding with our life & history.

We are prosumers. While so many activists in mental health reform have changed the system for the better through their years of advocacy, hard work, blood, and tears. Their lives were at risk, and the fruits have been born from thereto. 

The story of our mental health disorders, and the tenure of our recovery, weren’t depicted in the film One Flew Over the Cuckoo’s Nest. Our state hospitals were appointed with big-screen televisions, computer rooms. We had the works! The state hospital was had a first-class lounging area to relax. 

I wasn’t chained to a twin bed on a metal frame in a warehouse. Today, I have a job. I am happy, and I am a good advocate. I am also an enemy of the mental health system; the people around me fear me. I am not talking about the system’s operants or the powers that be in the operation of care.

The knowledge and professional license we have continue to be a threat to the powers that be in the mental health movement. Reformers will say that I have ‘signed off o’n the system of repression.

Well, our interests or careerism are not in question. We prosumers have witnessed from both personal experience and professional, what works, what doesn’t, and have been a victim of a system of oppression.

This dual position also means we have bold ideas. Bright Ideas of what needs to happen, and what isn’t happening in the mental health system. What that looks like for people like me and those I serve in the mental health system.

When our ideas are put into play and given air time. People thrive, diagnoses are understood as what they are, and the system shifts for the better that much further.

This potential is what I think is in crisis. The potential we prosumers have to change the system. I have talked a lot about the disjointed mental health movement. I have talked a lot about what I see needs to change and how to go about it. I have also seen what this can mean for people in real terms.

People with a covert plan have tried to use me in the same way so many peers and people with lived experience have been co-opted into the system of care. I will no longer let these folks derail and pollute my vision or the purposeful steps I take to bring people lightening speed knowledge. To truly change the system, we must pass through some trauma, so it does not accumulate and harm others.

Our lasting promise to the movement is to always be true to our authentic selves. We have seen all too often the danger and damage to the mental health discourse when authenticity becomes an endangered species in the system.

Breaking The Rules Saved A Man’s Life

Photo by Jayden Burdick on Pexels.com
Photo by Rakim Davis on Pexels.com
Photo by Zachary DeBottis on Pexels.com

 

I told him he “looked like shit” and asked if he had slept or eaten.

 

I was a street kid and not a college boy, and he knew it; it was and still is obvious.

 

 

Written by Craig Lewis, The Author of “Better Days — A Mental Health Recovery Workbook” and originally posted on the Medium Publication ‘Invisible Illness’on August 24th, 2019

Photo Taken in London, England, by Craig Lewis. 2017.

‘Identity Politics’ and Mental Health

In the mental health system today, identity is very imaginary and rife with politics. Take a look for yourself and step inside a vast channel of never-ending systems issues and clinical jargon. Somewhere along this ride is the authentic self of the clinician and peer. 

Cultural re-appropriation is rife and considered business as usual in Western psychiatry. 

I want to make a term visible and define it: ‘Passing.’ Passing is the act of concealing to hide or disguise a piece of a person’s identity as if (insert pronoun) ‘naturally’ is a part of the dominant group. To excavate just enough meaning to get a ‘working’ understanding of the language so the reader can repurpose these ideas and take them in (insert pronoun) journey through the system.

These terms evoke other ideas and theories. Some of them, include right to ‘ownership’, ‘diversity’, ‘equity’, and ‘inclusion’. The capacity to interfere and eliminate discrimination based on lived experience and belonging. To make these secondary concepts more meaningful, I want to share an anecdote from my experience as a Peer Specialist working on an ACT Team with shared clients.

The Vocational Specialist and I had a good connection with a particular client. Given that we were on a team and helping this client work towards a goal, we tried to align our interventions to reach this goal: acquiring a pair of shoes for the client. To make matters more complicated, the client had a history of ‘splitting’ team members and having them work at cross purposes. The splitting came off as innocent. The client began making minor, cutting remarks about other team members’ abilities in front of select members of the team. 

My understanding of my own client’s mental status was ‘crippled.’ Conflicting reports about my client began to circulate, and I needed to apply a great deal of re-engagement to get treatment back on track. 

I was expecting this. I was no stranger to working on my own when I was either the sole ally in a client’s life or the only team member working with a few clients on the roster. 

My position on the team was somewhat strange- given my disclosed lived experience and my clinical role. To fulfill my job responsibilities and work, I would have to cover one identity in favor of another to do the work without stepping into a dangerous dual role. With dual roles and a complicated identity game, I did not expect the client to turn my lived experience and use it as a bargaining chip to position my teammate and me against each other. 

He was a police officer before joining our ACT Team. 

Police officers don’t come from a homogenous population. All walks of life become cops. And yet, all cops must assume this single identity as an officer of the law above personal reproach. In this sense, officers must cover aspects of the essence to pass as this monolithic police force. In terms of ACT teams, most of our clients, especially those we were working with, had a history of trauma from police intervention. The vocational specialist was competent to keep this information to himself, at least, until it could be unpacked at a later date if it ever surfaced.

The question is: if you’re not a peer, is there ever a reason to disclose lived experience?

One day, I stumbled into a minefield of questions regarding the vocational specialists’ training and history after one of his visits went sour. Given we are a team and work to patch up rapport gaps with mutual clients, I allowed myself to walk into the minefield of identity, exposure and got very hurt in the process: “why was he asking me all these questions? The client asked me. 

I explained to the client that he was doing what he knew, given his training and style. He wanted to learn more about you (the client) to serve better and make sure the client reached the goal ultimately went the plan and the shoes obtained. “He was a police officer before he came to the team, and this is him learning how to serve you better”..” A cop!!!! Oh, no, I’ll never speak with him again” (inconsolable cries and muttering). Indeed, this is an example where identity politics can devolve into a sordid game of ‘othering,’ and later, in this mental health example, ‘splitting.’ 

My mistake was I shared someone else’s experience in life to engage with a client on my level and terms. In doing so, the team member whose identity I revealed no longer had space or the option to pass or cover to complete his job work and engage with clients successfully. In a clumsy, albeit gungho attempt at team diplomacy, I revealed the team member’s history before working on our team, possibly putting him at risk of violence and certainly disengagement in the rooster when working mutually with this client. 

While I had the best intentions, I DO NOT ‘own’ my team members’ history, and I had no right to disclose it to others. My team member had every right to cover as a former job as a cop (albeit with some visible pushback and clumsiness) to keep his safety intact and continue passing as a viable ACT team employee. Now, here is where things took an even darker turn for our team. Despite processing all of this as a team together, the incident continued to leave a lasting mark. The vocational specialist fed into the client splitting and refused to relate with me or work with me further.

Now, the futility of this is apparent, but the long-term implications to mental health are clear. When we use identity politics to scorn and ‘disable’ pathways for ongoing dialogue, communication, and discussion, we let our niche and bold identities become the very flags hailing our surrender to microaggressions and infighting in mental health.

 

Melancholy

‘Depression’ is a word that anyone can use, whether clinically trained or not. It therefore tends to be over-used.

It needs to be differentiated from ‘sadness’, which is the normal feeling associated with unfortunate events.

The deliberately complex term ‘involutional melancholia’ helps to identify a clinical state in which we turn in on ourselves, even when there is nothing particularly distressing in our current lives.

Laymen would be unlikely to use this term.

But, if they were to do so, their doctors would hopefully learn to avoid the automatic prescribing of an antidepressant.

By recognising that an involutional
melancholia comes from within, doctors and patients alike may separate this from sadness caused by external circumstances.

They may also come to see that an involutional melancholia is the precursor of addictive behaviour.

In effect, the states of ‘depression’ and ‘addiction’ are the same thing, before and after ‘treatment’ with a mood-altering substance or process.

This explains why ‘antidepressants’ are addictive.

Antidepressants are a curse in modern Medicine.

Sufferers from ‘depression’ have fearful difficulties in trying to come off antidepressants because they revert to their involutional melancholia.

This would be more appropriately treated with the Twelve Step programme.

They are vastly over-prescribed, they are ineffective and addictive. That’s a triple whammy if ever there was one!

Getting through the vicissitudes of coronavirus incarceration or illness will certainly not be assisted by antidepressants. At best they put people into limbo land.

MARCH WINDS AND APRIL SHOWERS BRING MAY REVENGE

In 1886, a proverb came into being: “March winds and April showers bring May flowers and June bugs.” Some people have altered the meaning and made it into a joke. March winds bring April showers which bring May flowers, but what do Mayflowers bring? The answer is “Pilgrims.” Not very funny, but very punny, one might say.

The saying is also altered for this particular story, “March winds and April showers bring May revenge.” It begins in Delray Beach, Florida, a warm sunny day with no clouds in the sky but quite windy whipping across the land. A man, 39, born in Houston, Texas, sitting on a red rusty bench in front of his house. He is both contemplating his past and thinking about his future. What was done is now done, he thought to himself. He cannot change this, but this mantra can guide life ahead. This man is feared by many. His name is Eddie Franklin, Jr.

His ex-wife is Laura Haines, 38, with long light brown hair and eyes. She stands about five feet four inches and is extremely thin, and has long, slim legs and well-developed arms. She is outgoing and has several friends nearby. On December 13, 2001, they were married and had no children and were divorced precisely five years later. During the entire marriage, people speculate that Laura had extramarital affairs. Jake Pierson, 39, Eddie’s best friend for many years. They met in first grade, and they spent lots of quality time together.

While drinking beer and watching Cowboys football together, Eddie would fantasize about catching touchdowns and getting all the women he wants. Something was off because he was cheating on his best friend. They eyed the same woman since high school, and she wanted to love them equally, but that is not possible. So she picked Eddie to marry and stay in love with Jake. Within a year after the divorce, Jake Pierson married Laura Haines. For many years, Pastor Joseph Meyer, 61, has led the church a few blocks from where Eddie and Laura lived. During all this time, he helped Eddie through his issues. Their talks began in first grade. Then it was a teenager, falling in and of love. Pastor Joe, which is the way he wanted to be called, officiated at Laura and Eddie’s wedding.

Besides, he intervened where necessary to keep their marriage together. What changed was when Pastor Joe married Laura and Jake. One day after his ex-wife’s wedding to his supposedly best friend, he was thinking about his first-grade teacher, Ms. Nancy Barnes. She was a total knockout, young and stunning. While she instructed us,  she was only twenty-five, with long blonde hair, deep blue eyes, with a huge smile that made her vivacious lips more inviting.

As a teacher, she led by strict rules. When you answered her questions, you needed to be always correct. If not, they were to put both hands on the desk, and then she would take out a ruler or some other instrument and strike us. The more wrong the answer, the more complex and the amount would be, ranging from one to five. 

And there was Cedric Downs, who was Eddie’s Lawyer Accountant. Although he was 78, he helped keep Eddie in the black. Also, he needed legal representation, and he did that as well. For Eddie’s divorce, he did not defend him and thought it was the right decision, and he took Laura’s side. Cedric was a heavy drinker, and he liked to play the horses. However, he was not good at it and often lost lots of money, a couple of times in the thousands. Since Eddie was twelve, he was always in trouble with his first arrest on August 13, 1993, for shoplifting. He was born on February 13, 1981, but he grew up relatively poor. At age 17, on November 13, 1998, he stole a TV and a couple of laptops because his family needed them.

The police arrested him, and Cedric was there, and charges were reduced. Almost two years later, he tied up, strangled, and killed Nancy Barnes with a ruler and other instruments. With masking tape, Eddie closed her mouth and her eyes, so she saw no one and could not say anything. Of course, since she was dead, she did not. 2001 was a unique year for Eddie. April 13, he shot and killed his ex-wife, Laura, and her husband, Jake Pierson. When he finished the killings, he robbed their house. On July 13, Eddie attempted to beat Pastor Joe to death outside of his church three months later. But the police were walking by, and Eddie was arrested for attempted murder. Again, he was defended by Cedric Downs. He was convicted for twenty-five years to life. Eddie had issues to deal with a few years earlier, so Cedric agreed to take him home. Other than the names above, most of what you read never actually happened. 

What did occur was that Eddie had an episode of Paranoia or a form of Schizophrenia where he thought this transpired. On his seventeenth birthday, February 13, 1998, he was diagnosed with Paranoid  Schizophrenia. A month later, he was committed to a Psych Unit. He was hospitalized on and off for the next eleven years. For those years, everything was real for Eddie. His treatment was agreed upon between his entire team, Eddie included.

With therapy every other week and medication from a psychiatrist monthly, his life has improved. His symptoms happen less often. During his recovery, he got married on December 13, 2002, to Laura Haines, and they have two kids, Katy, 14, and Ian, 12. Also, Jake Pierson was his best man, and Pastor Joe performed a wonderful ceremony. Furthermore, he has been an Architect for the same firm for eleven years and in 2019 was promoted to Senior Architect.

As one can see, having a Mental Health Issue can control one’s life. With the proper treatment and a healthier environment, one can exact revenge on their mental health issue. There will be bumps in our road to recovery, but we will survive! Eddie survived. This writer has too, and others can. 

MENTAL HEALTH LIVES MATTER. See you in the NewsBlogs.

Lived experience as a self-diagnostic tool  

The concept of recovery and healing is so complicated. Let us assume that people ‘heal’ as a by-product of their recovery, including many other aspects.

 

These aspects include their overall stance on healing, approach to recovery, rate-of-recovery, and so many other nuances that contribute to our overall healing from trauma, self-inflicted harm, and organic brain disease. I would like to explore my own lived experience with first-onset psychosis.

 

I always knew the qualities of my personality were altered by schizophrenia. I approach problems differently today than before my disorder. I even approach positive insertions into my life differently today. These insertions can be as simple as good conversation during the workday or meeting a new person and experiencing a budding relationship blossom. However, what exactly do I mean by different? The difference is at the level of how I handle such occurrences. These extend beyond the normal development of my personality, I believe. We all grow and mature over time. There is no question that some of the changes I am gesturing towards are due to my development’s natural progression. However, I know myself better than that. I also know I have had to mature a lot faster than most people my age.

 

This is mainly because, developmentally, I cannot afford to make the same mistakes people at my development stage make. Since my psychological landscape has little room for error, I need to be extra cautious, extra careful, and speedy in how I go about maturing and the maturation process.

 

I need to handle things differently. However, my question is: how much of this is a by-product of the changes due to the first onset? I genuinely wonder if the resultant changes that manifested in my brain necessitated me to handle things differently. Meaning, because my mind now functions differently, is the need to feel things differently from the first onset, or is it a result of how my brain went about healing? Are the changes the direct result of trauma to the brain or the development of my mind healing ‘normally’? I will tell you one thing. For the most part, I have not changed how I handle things because I wanted to be spontaneous and change things. No, I have had to because, after the first onset, I was so disordered that I could not speak intelligibly enough for others to gather anything meaningful from my speech. I have written extensively on stilted language and the changes during my episode when the first onset first hit my brain’s synapses. However, I rarely evaluate how my speech was before my disorder and after my recovery. More importantly, given my findings, how I find my own brain’s capacity to heal from psychosis? I am no speech analyst. In truth, my expertise is in rhetoric and only helpful when studying the words used, delivery, style, memory, and delivery.

 

However, even with my limited knowledge of how rhetoric works. A side-by-side comparison of my speech and ability to communicate before the first onset and after is bothersome on many levels and remarkably telling on others. Incredibly speaking of the energy, I invested in my recovery, the specific skills I was able to relearn, and how far I could push forward in areas that benefited from relearning how to speak and communicate. That is to say, not every aspect of my rhetorical canon was repaired or responded to the work I invested in regaining my language facilities.

 

In my 2006 Radio Show, County Speak, on WHRW 90.5 Binghamton, I was at the height of my college speaking career. Thoroughly before any schizophrenia symptoms, I was in complete command of what I wanted to say and how I went about saying it. After listening to the show alongside a recent interview from this year, I was taken aback. I sounded like an altogether different person years ago.

 

Let us break it down on the level of rhetoric. In terms of style, my speech was certainly more spontaneous in 2007, with less effort and energy expended on my part to seem so. My memory was remarkably better in 2007. I needed to pause less to gather my thoughts, and the flow and diction were more even and smooth. All these aspects of rhetoric have taken a turn after the first onset.

 

These aspects of my speech responded well to the effort and energy I invested in my treatment targeting my language. However, they did not reconstitute completely and heal up without a hardened scab and layer of nonfunction or impairment, still visible to this day. Only on the level of delivery have I been able to learn how to be more impactful. This has nothing to do with my illness, however. This harkens back to what I was speaking about earlier. That I have had to invest a ton of energy into the process, and my delivery, how I capture my audience’s attention, keep it, and redirect my life’s sheer inertia into the work is clear as day and uncontested.

 

I cannot help but cite the greatest, Mohammad Ali, who was not as fast on his feet as he once was after returning to boxing after years of political exile. He learned to lean on the ropes with the famous icon ‘rope-a-dope’ strategy and outpace his challengers with the imposition of will and his unrivalled stamina. While I am not as savvy with my ability to choose words as quickly and effectively or speak smoothly and spontaneously, I have learned to lean on my energy.

 

My sheer will to rise above my impairment is genuinely the main asset I have in my corner. Sure, identifying my weaknesses and pinpointing what works and what has not along the way was also important. However, indeed, my energy and the level of intensity I put into the work ahead is what continues to drive my healing forward.

Socializing in the ‘Mental’ Hospital

After being admitted to an inpatient hospital setting, settling down on the unit as best as possible, and changing into hospital garb, there is little to do than to sit and wait for your treatment team meetings, medication administration, meals, and pace up and down the hallways. Another option for passing the time is socializing with other peers on the unit. Of course, socializing has its advantages and disadvantages and risks too.

Peers on the unit carry with them insight (or lack of) and stories that can pass the time on days when you need to escape, if only mentally, the confines of the unit. After so many hospitalizations, I have experienced the benefits and drawbacks of socializing with others in the hospital.

Without question, peers on the unit each have their history. Their ‘stories of how they discovered themselves within an inpatient setting and their versions of the precipitating events to their hospitalization. As you get to know each consenting new friend on the unit, there is a little bit more to learn each time.

I use the word ‘consenting’ because not everyone on the team will be friendly or healthy enough to engage in meaningful communication. Depending on the level of care, state hospitalization versus community-based hospital, there will be a difference between the capacity of most peers on the unit to communicate.

In some cases, there are differences in approachability between patients. Either due to possible aggression or confusion and agitation, the ability of a peer to make a connection with another peer is a precarious venture in the hospital.

Stories from peers can and probably will be highly vivid, sometimes dark, and usually bizarre. At the same time, most people talk about their potential and future discharge.

You may be lucky enough to catch someone in their low-level manic reflective mood talking about their feelings on how they ultimately needed the hospital.

In doing so, the story will also, no doubt, be a litany of extremely unfortunate and lousy luck culminating in this ‘eye’ opening hospitalization.

I have heard stories of all kinds, painted in both broad and sophisticated strokes depending on the mood, verbal acuity, or level of self-disclosure opted by the patient telling his story.

I had many peer relationships in the hospital. There was one patient I got along with enough to talk with regularly. In her case, it seemed as if she was recovering. So, I invested my energy in speaking and trying to connect with her.

One day, however, I noticed it seemed as if a switch had flipped, and all of a sudden, she was talking to herself again and responding to internal stimuli. One day, I noticed she was talking with hospital staff and pointing towards me. I was sitting on the couch in the day room at the time. I observed the team approach me and asked me what I was doing at the moment. They told me there was a complaint from my friend that I was threatening her. I told the staff they must be mistaken because we didn’t even speak to one another during the past few hours. A week passed, and my friend was transferred to long-term care and extended ongoing treatment unit. Patients are sent to when they begin de-compensating further upon the initial trial of symptom stabilization on the admissions unit.

I have met people so disordered that they cannot maintain a conversation without spinning out in tangents and non-sequiturs without end. I have also met people so reserved and seemingly together, I wondered why they were in the hospital. One memory I had is a man who took an interest in my books, and we would talk about philosophy whenever we had the opportunity to speak with one another. I couldn’t figure out why this man seemingly so composed was in the same unit as me. All the suspicions and questions became answered when the buzzer went off, and I heard screaming.

Before I knew it, staff called code.

Before I came to my senses, he was restrained in a crash cart. He had attempted to harm himself. Months passed, and he never returned to regular clothing. In his room, mostly isolated for the tenure of my hospitalization, he remained in hospital clothing, very depressed looking and not at all appearing or behaving like the same person I had met when I was admitted to the unit.

In my university yearbook, which my family surprised me within the hospital since I graduated a few weeks prior, I have several comments and signatures from other peers on the unit. In the pages are inscribed well wishes and hope for a better future. There is no question that our peers’ messages, stories, and suggestions during difficult times give us pause, solace, and inspiration to keep living the best life we can achieve despite the challenges and ghosts from our troubled past.

Together, I hope our collective narrative will live on for another day somewhere far beyond the confines of the unit and help you take on a life far above the upper limits of yesterday’s problems.

STIGMA: PEER SERVICES, DOUBLE STANDARD, AND SELF-DISCLOSURE

There is an unspoken, covert, and arbitrary double standard for working in the mental health community as a peer. In this land, discrimination goes without question sometimes. The double standard exists in mental health agencies everywhere. The insidiousness of this double standard runs deeps.

As a professional in mental health, I have seen the depth of this discrimination at various levels and intersections of “agency.” From Human Resources (HR) to Operations, Clinical work to Peer-run departments, there is a misinformed set of expectations and beliefs involving peer work looming over the entire mental health “agency” setting.

The double standard exists because of a culture of mental health medicalization. The DSM-5 has codified the symptoms of mental illness for clinicians. However, all of these symptoms are subjective. If someone who has not disclosed a diagnosis reports having trouble sleeping, or feeling down that day, no one would think twice about it. But for peers, who are labeled with an illness, these same experiences become seen as “symptoms” and force the other agency members to question the peer’s competency. 

Think about it. Peers, through the act of self-disclosure, reveal their lived experience at work in the agency all the time. Through the act of self-disclosure, these peers are revealing their lived experience to other peers, but also clinicians, psychiatrists, social workers who are very much bound up in a narrow-focused idea of good mental health.

For most clinicians, peer work not only continues to be misunderstood; it is viewed with the lens of the prescriber or therapist as work by people who are still disordered or sick. Despite the supposed egalitarian non-hierarchal landscape of interdisciplinary teams (e.g., ACT, or Assertive Community Treatment) in mental health, peers are certainly not understood as being as healthy as their fellow clinical counterparts in the mental health agency or when working on the same team.

I have worked in several mental health agencies and settings. Each experience was invariably similar, especially concerning the informal set of questions and comments circulating about the peers’ job performance and health. As far back as I can remember, the peers at my agency were under constant evaluation since they were hired.

Even more troubling, after working there for some time, the peer still seemed to be under continuous and informal assessment from colleagues without a disclosed diagnosis. For everyone else at the agency, the assumption was that they could do their jobs, that their health would not get in the way. But for us peers, the assumption was that our quality of work was always questionable, our health always on the verge of interfering with our jobs

While the level of “functioning” is now generally accepted as a dated clinical term, it has sadly found new meaning, traction, and use against the peer community. The peer’s work readiness and ability to perform at work given his or her preexisting mental health issues are always under question. Even worse, the lingering questions around health, in my own experience, have risen to more than just conversation around the water cooler. I have observed these questions rise to HR and even result in unfounded termination from employment.

In every agency I have worked for in New York state existed a secret conversation, an informal meeting, and ongoing dialogue about a particular peer’s mental health status when an incident or unexpected event occurred. For example, if a peer called out sick, or there was a new and unusual behavior in the peer’s day-to-day disposition, all of a sudden, that peer’s competency was under question.

I knew plenty of professionals (e.g., therapists, social workers, psychiatrists) that would talk about “fucked-up marriages” or “explosive” behaviors at private social functions or work. Somehow, someway, these professionals are not considered sick or in need of treatment. These behaviors are widespread. What is not so common is the license for peers to mimic this behavior.

Peers who want to feel comfortable in their shoes being themselves without fear of losing their jobs or respect from their colleagues cannot behave like this without fear of being called “sick.” The etiology of this discrimination runs deep. Therapists and psychologists without any lived experience are somehow above reproach. The same behaviors that are viewed as normal and understandable when exhibited by therapists and psychologists are considered symptoms of an illness when peers exhibit them.

This disparity was so visible and yet so brazenly discriminatory in the jobs I have held. I’ve suffered trauma from the entire experience of working as a peer with lived experience.

As a peer, my education, disposition, presentation, focus, and ability to do a job are under scrutiny. Given that we live in a world of stereotypes, discrimination, and labels, peers are always judged by other team members when working in mental health or interdisciplinary teams. We are considered not quite healed yet, or in need of further recovery to be successful or ready to use.

After openly disclosing my lived experience while working as a clinician, I heard colleagues’ comments, the smirks, the language thrown around the watercooler. These were comments about my ability and calculated as a general summary of perceived progress and recovery status from a diagnosis. My colleagues would talk about how recovered I was, or how healed I was from my illness. Even worse, my recovery was taken out of a more human context and discussed only in clinical language. I felt like a textbook example on the agency’s list of “recovered” peers.

My point is that peers’ worth and abilities seem to be summarized by their so-called functioning level. A peer’s ability is determined—by clinicians and their colleagues in the system—to be only as good as their ability to come across as healthy to their fellow team members. The standard is as absurd as it is arbitrary. Since there is no clinical determination or assessment of seeming healthy, the peer’s health status is bound up in a world illusion and discrimination.

The double standard requires peers to demonstrate their skills and talents to help people heal, be publicly comfortable with their problems, and work alongside social workers and others in the helping profession. In doing so, peers handle the same or even more severe issues but are deemed less able to compartmentalize problems and engage in self-care.

This is clear evidence of a double standard and attitude that favors and privileges one side of the binary—the clinicians—over peers. This discrimination must be made visible and revealed to mental health advocates and changemakers. Readers of this article must take this information and begin to explore this discrimination at various levels of the mental health sector, including advisory boards and other apparatuses above the agency’s level. Only in the larger arena, above the agency’s auspices, will we be able to put a stop to this double standard once and for all.

Psychotherapy and Social Work: Ethics, Judgement calls, and Supervision

The ethics of workers in the helping profession are continuously under the radar.

Help seekers, colleagues and other professions in vastly different fields continue to question therapists and other helping professionals’ ethics, values and intentions, understanding this suspicion aimed directly at therapists.

As a help seeker and a social worker bound by a written code of ethics, the stakes are even higher for ethical rigor when practicing. This writer’s experience practicing psychotherapy grows simultaneously with his professional and ethical wellspring for producing good outcomes at work.

Indeed, we therapists have learned a compelling set of skills when it comes to our ability to intervene with our client’s affective state and, even more potentially dangerous, their cognition. This same set of skills that have the power to soothe, de-escalate, and dig underneath psychological trauma and years of unhealthy thinking have a dark side, too, and vastly dangerous potential to hurt and do collateral damage with little time, energy or assets expended on behalf of therapist.

As a person carrying a schizophrenia diagnosis who can be very paranoid, I have personally questioned workers assigned to treatment. Paranoid from working at cross purposes with a therapist in the past regarding care coordination with a clinic. Even go as far as saying I have been at odds with therapists to provide personal clinical mental health treatment and therapy.

I wonder: why is this the case? There have been times when this writer has personally experienced mistreatment and felt the fall out of bad judgment calls by therapists and wondered: why is this happening?

As a therapist practicing in an Article 31 clinic, the answer is more straightforward with its regulations and code for practicing psychotherapy. Sure, with rising caseloads and no show policies regarding client attendance, who has not experienced the pushback from supervisors and directors who need to balance the numbers?

When it comes to keeping the clinic’s doors open, ethics sometimes become blurred when they should be as clear as day.

I am talking about something entirely different, however. To be candid, triggering clients intentionally and not for any so-called therapeutic probing and identifying a client’s distress tolerance or intolerance, but the vile digging into wounds without regard. The wanton and willful neglect of signs of self-harm or harm to others (HI/SI-homicidal and suicidal ideation) for whatever reason, and the subsequent improper documentation or missing documentation of it all to hide the crimes inflicted upon the client.

Sure, horrible and tragic mistreatment happens in hospitals, clinics, nursing homes, adult homes and any treatment setting run and operated people with unsound ethics and questionable values. Therapists, especially social workers, must write essays and documents in writing their stance on the NASW Code of Ethics.

This ethical code written by social workers outlines social workers’ general and specific stance on a litany of essential value-points and provides guidance, with little ambiguous language, where the line is when harboring biases, judgments and client contact when practicing social work. Indeed, we social workers but get to know our values, biases and vast intersections of power, privilege and judgments that impact client care. All of these personal and professional reflective opportunities are important, but are these academic measures enough?

As our clients’ chronicity increases and the intensity of their symptoms spike without fail, who has not felt the transference and countertransference issues in their practice? I will never forget speaking with the clinical supervisor years back when she first started.

I said to her: “Transfer this client, it is not going to work, and someone will get hurt.” I pleaded to the supervisor. The supervisor was new to her position, eager to troubleshoot clinical problems and make it work.

I was not the person who was going to help this client. To be even more precise, knowing this person needed help, but I could not help. Firmly believing that there are people we cannot help as individuals and when charged with their care, providers must ethically make immediate provisions for their discharge and transfer to someone that can help. In this case, it was not an issue of choosing the right treatment fit, per se, but instead, moving this client through the system into space where the right clinician could intervene.

One day on the way to work, I got a text message from this client’s mother. The client, the same one I requested be transferred, attempted suicide the night before. I will never forget reading that message, and pulling over to the road, pained, hurt, angry, and all the emotions that come with the request not taken seriously. When the time finally came, and the client finally attempted suicide. Even this ethical problem does not speak of the willful and intentional breach I am gesturing towards, which happens all the time, just shy of physical and psychological terrorism inflicted upon this vulnerable population worldwide.

To be sincere. There have been times when this writer’s professional shortcomings were made visible and evident by the clients I have worked with without success. There have been times when the impulse to lash out at the client has crossed this mind in session. Call it lack of faith in recovery, term it transference or countertransference, or unprofessionalism and questionable values. Ever feel this impulse? I have a first hand in the field, in the clinic, and even in the documentation.

Even while writing and documenting cases, this writer has felt the urge to go ahead and use language to trigger, hurt and shame others to get the message across at all costs because the client’s life depended on that even if it meant taking the risk of de-stabilizing a client’s emotional state.

Of course, like the therapist who triggers his or her clients in a controlled environment, to map-out their clients distress tolerance skills, would only use language to de-stabilize for the purpose and aim to bring the reader to a more profound truth and insight into the world and their knowledge of where they stand in its ever-changing and rolling landscape of psychological land mines and personal plight.

Ultimately, are there others out there who feel the same way I do? Are their other therapists, psychologists, psychiatrists and peer professionals who have felt the same impulse I have to do good by any means necessary? Does this any means necessary idea of “help” genuinely helping? Where does the pendulum swing on the scales of good versus evil for this therapist and colleagues?

Reflections on ‘Peerness’, Social Work and Supported Housing

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Mental Health Affairs 2022

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